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Author
Topic: Reinfection? (Read 9211 times)

I searched to find this topic here but i could not see it , so my question is hence i am hiv+ with undetectable then i met a woman which i don't know her status all of a sudden we have unprotected sex though i told her to use condom she said no,i tried my best to convince her that i don't want her to have a baby.though i consider myself been undetectable the risk of infecting her is low,but how about if she's possitive not on medication,what will be my risk on reinfection like anotherhiv not STDs?

Astonished at your question.You should be asking if you could have infected her.Reinfection , if it exists ,seems to be what you are looking for.I should not judge others, I accept the blame, but you should know better than this.Use condom, please, or you, others, or future others could be at risk.

Sorry, Sanitex, unable to offer much advice or support here. You need to tell your partner though.

And ... seriously?

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

If you are going to have unprotected sex with anyone, you have a moral obligation, and in many locations, a legal obligation, to inform them that you are HIV+ so they can provide informed consent. What you did was incredibly risky for the woman, as the receptive partner she is at much higher risk of becoming infected than of you becoming "reinfected" if she were to be poz.

I believe you now have an obligation to inform her in some way, whether directly or anonymously, that she was exposed to HIV and that she should be tested for a couple times, up to six months out from the exposure. Also, in my opinion, I think you need to check your moral compass and stop thinking with your cock!

I find this post to be irresponsible and insulting. Sure, this woman could not be convinced to have sex with protection, uh-huh. And still you worry about the possibility of being reinfected instead of what danger you may have presented to her. Come on!

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"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

I find this post to be irresponsible and insulting. Sure, this woman could not be convinced to have sex with protection, uh-huh. And still you worry about the possibility of being reinfected instead of what danger you may have presented to her. Come on!

In sex, heat of the moment, shit happens, it's not a real estate transaction.

Firstly, we don't know whether our friend San, did or did not disclose his status. I do believe he has a moral obligation to do so (legal one, crock of shit, this is between two people).

As a matter of fact the risk of transmission is not "incredibly risky" it's very low in the circumstances cited.

As to the OP's substantial question, San, on reinfection, the chance is so very small if you are on treatment as to be non-existent (both ways), unless (an outside chance) your partner had a massive viral load and resistant strain, in which case it is possible but still very unlikely. But, if you's gonna see her again, you know there is a conversation to be had...

As a matter of fact the risk of transmission is not "incredibly risky" it's very low in the circumstances cited.

Then why do pretty much all HIV med prescribing information sheets say that the drugs DO NOT reduce the risk of HIV transmission? Hmm. There have also been studies that have shown there is not a correlation between levels of HIV in the blood and HIV in the semen. Unprotected sex as the insertive male partner whether UD or not is quite a risk and should not be condoned.

A bold statement, perhaps worth justifing with reference to the literature, including the latest research showing variation between genital tract and blood viral load may well be a factor of adherence (in women anyway).

Otherwise, say I believe when you post. Ta.

People need to understand that the research, es eg per Dr Bernard Hirschel's summary of the evidence, that - on a population level - condoms are as effective as having and undetectable viral load in terms of reducing transmission.

But it doesn't say how much virus or whether it's infectious and doesn't really reference heavily treated HIV. And it is in no way comparable in terms of information about outcomes, ie transmission, to the many large cohort and randomised studies which show very small/no risk of transmission or indeed few/no actual transmissions when viral load is fully suppressed.

Close but no cigar #2. It's hard when giving personal health advice to quanitfy low and very low risks. And I note the answer in the Q and A is no more precise than saying low. Probably the same answer, or a near enough same one, would have been given for condom use.

It is a leap of faith perhaps, or change in frame of reference, from condoms = protection to no condoms = no protection in all circumstances, but treatment changes this. The difference between condoms and no condoms is the barrier. That seems about it. On a population level, condoms are comparable to suppressing viral load in terms of protection.

This in no way says anything about disclosure, because I believe, ideally, you should say regardless. But here is something to behold as worthwhile, something new in prevention, and for the record acknowledged by the courts in Canada and health authorities in many places.

"The study’s authors acknowledge that poor adherence could have contributed to the failure to find that ARV therapy reduced transmission risk."

I've written research papers too. You have to come up with every possible reason your results could be wrong! That doesn't mean that is the case. Odds are, the results stand. They're just covering their asses, as the term goes. It seems there is a lot of hesitancy to believe the being UD doesn't mean you have a low or no risk of transmission. What, are people going back to barebacking after the reach UD or something and are now just trying to justify their behavior?

Odds are, the results stand. They're just covering their asses, as the term goes. It seems there is a lot of hesitancy to believe the being UD doesn't mean you have a low or no risk of transmission. What, are people going back to barebacking after the reach UD or something and are now just trying to justify their behavior?

I don't think this has anything to do with barebacking, as much as the science of transmission. The highlighted words mean to me that you have a bias in this discussion. They admitted that their study may be flawed because they don't know how good the adherence of their study participants was. Had all those participants been undetectable for six months prior to removing the latex? There are a lot of questions unanswered here. I don't hold the Swiss Study up as the holy grail of all research, but I don't discount it without some proof either.

I don't have a bias, I have science to back ME up. NOT just the Swiss Study either. I'm showing you guys repeated studies and evidence that sex can still transmit HIV after a person is UD but it is being ignored. Here's more:

Do we know much about access to HAART in this part of China? Or, if these people are more likely to have adherence problems due to various factors? It would be interesting to know whether these people stretch out their meds to make them last longer. Or, if they do very hard work and often forget to take their meds. Or, whether they have total access and have as good adherence as the average person.

Modified:

The article says many in the town became infected from tainted blood donation equipment. We know many people are not totally monogamous. It is possible that the uninfected partner actually became infected from someone outside the marriage---since "many" in the town had become infected.

Which is to my mind more a accurate headline than the other reports (the error in emphasis is originally Aidsmap's, it's their headline).

The regimen in Henan is AZT + ddI + nevirapine, there are stock outs (witness the high level of resistance), side effects are managed poorly, if at all, so yes, treatment needs to be done properly if it is to be protective. But then so do condoms.

Having unprotected sex with a suppressed viral load is not a high risk activity. I did not say it has no risk, just the risk is very low. Witness the several people on these forums who have conceived naturally under these circumstances without passing on HIV.

I've been waiting for this article to be brought up. If you go on to read the further article at aidsmap, you find this information:

Quote

However, the investigators note that the high transmission rate seen in couples where HIV treatment was used could be due to poor adherence. A separate study showed that 66% of patients in Henan province had sub-optimal adherence to their HIV treatment six months after starting HIV treatment.

so once again we find a report being put out purporting that "reinfection" is possible, yet clearly that is not the basic result when 2/3 of the test group were not adherent to the meds and therefore might not have been UD. So far all claims about reinfection are based upon reports of people having unprotected sex and without being UD.

Of course if reinfection were happening as easily is claimed in the headlines and the general take-away from these reports, we should be seeing a high amount of cases reported as undetectable_VL-poz/undetectable_VL-poz barebacking has been going on for the last 2 decades. Instead what all the reports really can verify is what we already know - that detectable_VL-poz/detectable_VL-poz sex can lead to reinfection.

you might want to read a previous discussion about other cases in the thread Re-infection! which discusses how the other findings about reinfection were slanted as those cases had issues of non-adherence also. And don't forget that a person adherent to their meds, is basically following both PrEP and PEP. Not to mention the whole child-producing without passing the virus sex situations that Newt mentioned.

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leatherman (aka mIkIE)

chart from 1992-2013; updated 2/09/13 Reyataz/Norvir/Truvada

Granny60

Depending on what regimen you are on she is at the highest infection risk because some meds do not cross the brain/blood barrier nor genital/ blood barrier so viral loads can still be high there. Although it is "possible" for you to get a resistant strain if she has it, your greatest risk is from getting Hepatitis, Syphillis, or any of a host of other STD's which not only can make life more complicated, but increase your risk of reinfection. God gave you a brain.... you need to use it. Obviously you already know how to use the other parts he gave you. Please use protection. How would you feel if you have given her HIV and a child?

Depending on what regimen you are on she is at the highest infection risk because some meds do not cross the brain/blood barrier nor genital/ blood barrier so viral loads can still be high there. Although it is "possible" for you to get a resistant strain if she has it, your greatest risk is from getting Hepatitis, Syphillis, or any of a host of other STD's which not only can make life more complicated, but increase your risk of reinfection. God gave you a brain.... you need to use it. Obviously you already know how to use the other parts he gave you. Please use protection. How would you feel if you have given her HIV and a child?

Well, there are multiple people on this forum who have, while undetectable, had unprotected sex with their HIV negative wives specifically to induce pregnancy. In no case that I recall has either the wife or the child seroconverted. I know the plural of anecdote is not data. However, as opposed to studies that rely on patient report after infection, these examples have living, squealing proof that infection while one's VL is undetectable is less than high risk.

BTW, are there HIV drugs that do not cross the blood-genital barrier? If so, which ones? Are they prescribed in regimen alongside drugs that do? If so, then isn't the point moot so long as that barrier is otherwise breached and controlled?

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I find it very hypocritical that when it comes to oral transmission of HIV, most of the people here will not accept anecdotal evidence as proof of concept, but when it comes to UD people not transmitting HIV to their partners, anecdotes are perfectly acceptable. Hypocritical much?

I find it very hypocritical that when it comes to oral transmission of HIV, most of the people here will not accept anecdotal evidence as proof of concept, but when it comes to UD people not transmitting HIV to their partners, anecdotes are perfectly acceptable. Hypocritical much?

Um, no. because when many people stumble around with gunshot wounds and point to a specific weapon, that is evidence after the fact.

When that same weapon is loaded and aimed at a thousand people and it never fires, then it is ruled out as the likely source for the gunshot wounds.

I can wrack my brain, but cannot think of a way to explain it more simply.

I submit that hypocrisy comes from subscribing to a wensite because of it's scientific accuracy in determining/defining and explaining a disease and the means to treat it, and dismissing the same site's stated scientific explanation of that same disease's vectors for transmission.

Pick-and-choose scientific accuracy never worked for me. I am always amazed that it works for others.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

Then why do pretty much all HIV med prescribing information sheets say that the drugs DO NOT reduce the risk of HIV transmission? Hmm. There have also been studies that have shown there is not a correlation between levels of HIV in the blood and HIV in the semen. Unprotected sex as the insertive male partner whether UD or not is quite a risk and should not be condoned.

Thnk u Honey!I have had many people tell me that they are undetectable...(Just because u are undetectable in your BLOOD does not mean you are undetectable in your SEAMEN) I feel like many people use the fact that they are undetectable as a excuse to have unprotected sex. I will say that the "risk" of infecting someone is alway's there, no matter the level's or status.

And yea I kinda smell some b/s to be honest.. And like a lot of other's have also said you are worried about you being reinfected then infecting her? All I have to say is that she need's to go get tested now so she won't spread the virus!As far as telling people you have sex with that you have HIV. You should tell every person you have sex with. If they don't want to wear a condom and you feel comfortable with that then go for it..I would never have unprotected sex with someone I told my status and they still didn't want to wear a condom.

The way I see it..Is if they were willing to have unprotected sex with me..A HIV positive person..Who else have they had unprotected sex with?And what risk am I putting myself in..(Hope I didn't offend anyone!)

I've written research papers too. You have to come up with every possible reason your results could be wrong! That doesn't mean that is the case. Odds are, the results stand. They're just covering their asses, as the term goes. It seems there is a lot of hesitancy to believe the being UD doesn't mean you have a low or no risk of transmission. What, are people going back to barebacking after the reach UD or something and are now just trying to justify their behavior?

OMFG!!I SERIOUSLY LOVE YOU!!!

I feel the same way! people do use the fact that they are UD to have unprotected sex...They are just "TRYING" to justify they're action's! (But what they do to them self's don't bother me one bit.As long as it don't affect me!)I do feel that being UD, there is a "lower" risk of passing on the virus..but like I said that risk is ALWAY'S THERE!...no matter what!I also do believe in reinfection!!( I don't think I will date a poz person(YET)...just cause of the fact that I feel that the person will want to have u/p sex..and with a neg person they will not want to..I want to protect myself and the other person)

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I meant to say "Or if you just want to keep pretending that unprotected sex if you're positive and UD is completely safe." I think that is the point. You guys keep putting forth one study (this so called Swiss Study) that says unprotected sex if you are UD is as safe as having sex with condoms. I'm providing numerous studies that show the sex if you are UD is NOT safe. Yet people seem perfectly happy to stick their heads in the sand.

Granny60

Well, there are multiple people on this forum who have, while undetectable, had unprotected sex with their HIV negative wives specifically to induce pregnancy. In no case that I recall has either the wife or the child seroconverted. I know the plural of anecdote is not data. However, as opposed to studies that rely on patient report after infection, these examples have living, squealing proof that infection while one's VL is undetectable is less than high risk.

BTW, are there HIV drugs that do not cross the blood-genital barrier? If so, which ones? Are they prescribed in regimen alongside drugs that do? If so, then isn't the point moot so long as that barrier is otherwise breached and controlled?

2010, American Society for MicrobiologyHigh Concentration of Raltegravir in Semen of HIV-Infected Men: Results from a Substudy of the EASIER-ANRS 138 Trial

The male genital tract, however, represents a separate compartment, or “sanctuary site,” in which viral replication may persist in patients receiving combination antiretroviral therapy, despite a complete inhibition of HIV replication in blood.

HAART dramatically suppresses HIV-1 RNA viral loads in blood and semen, but HIV-1 proviral DNA can persist in semen WBCs for months after the initiation of HAART . The method used to recover HIV-infected cells from semen in this study – separation of seminal WBC on Ficoll gradients – likely decreased the sensitivity of HIV episomal c-DNA detection because infected macrophages and a proportion of infected T-cells are lost through this approach. The paper by Xu et al. used a direct lysis technique optimizing recovery of DNA from HIV-infected cells in semen. Using this approach, combined with quantitative PCR and DNA sequencing, the investigators show that episomal 2-LTR cDNA is detectable in semen from a subset of men with other evidence of seminal HIV-1 infection. The marker was not detected in semen from 22 men at 1- and 6-months after peripheral viral suppression due to addition of Indinavir to their ART regimen.

There are many more such studies but I am not going to waste the entire night copying/pasting and butting heads with people who's only objective is to flame any post that pops up on their screen.

« Last Edit: October 17, 2010, 11:52:43 PM by Granny60 »

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Granny60

I meant to say "Or if you just want to keep pretending that unprotected sex if you're positive and UD is completely safe." I think that is the point. You guys keep putting forth one study (this so called Swiss Study) that says unprotected sex if you are UD is as safe as having sex with condoms. I'm providing numerous studies that show the sex if you are UD is NOT safe. Yet people seem perfectly happy to stick their heads in the sand.

A report disproving the Swiss study was the subject of an article on AidsMeds just a couple months after the original Swiss story release. I used to have a book that charted the Plasma, Seminal Fluid, and Cerebral Spinal fluid concentrations of different meds. I gave away most of my books a few months ago hoping that they might be of use to people before they get too outdated, but still have the Sanford Guide to HIV/Aids Therapy and will look to see if I can find a list. It might be useful information for those who want to have a child. I don't know what semen washing costs now, but i do know a person that traveled to Germany for semen washing and embryo implant and he told me it cost a shocking $50,000.00 to conceive that little girl. Damn lucky to be able to afford it I say.

I meant to say "Or if you just want to keep pretending that unprotected sex if you're positive and UD is completely safe." I think that is the point. You guys keep putting forth one study (this so called Swiss Study) that says unprotected sex if you are UD is as safe as having sex with condoms. I'm providing numerous studies that show the sex if you are UD is NOT safe. Yet people seem perfectly happy to stick their heads in the sand.

I absolutely do not say that, nor do I either believe it nor espouse it. But careful monitoring by a doctor of a male with the explicit intention of creating a baby has, in several cases, proven to be successful.

I repeat my earlier query: Which meds do not cross the blood/semen barrier? Are they paired with meds that do? If so, then what, exactly stands between a person creating a child with an UD VL ?

I am not being snarky, I am asking a question, a this is an area in which I have not done much research.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I absolutely do not say that, nor do I either believe it nor espouse it. But careful monitoring by a doctor of a male with the explicit intention of creating a baby has, in several cases, proven to be successful.

I repeat my earlier query: Which meds do not cross the blood/semen barrier? Are they paired with meds that do? If so, then what, exactly stands between a person creating a child with an UD VL ?

I am not being snarky, I am asking a question, a this is an area in which I have not done much research.

In several cases... well that's all well and good until this theory ends up with people getting infected, which in no doubt has or will, given the science. Also, I wasn't the one who stated anything about meds and barriers. I have no clue about that. What stands between a person who is UD and unassisted reproduction? RISK. Its like playing Russian roulette with someone else as the potential victim. Just suck it up and find a neg sperm donor, go for sperm washing, or adopt. Don't risk your partner's health. Unless of course in some sense of logic it seems to make sense for one person to become infected with HIV in order to add to a family, then maybe go for it.

Granny60

The link to the 2005 study as posted above lists Indinavir which is brand name Crixivan as crossing the genito barrier. paste again:The marker was not detected in semen from 22 men at 1- and 6-months after peripheral viral suppression due to addition of Indinavir to their ART regimen.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

In several cases... well that's all well and good until this theory ends up with people getting infected, which in no doubt has or will, given the science. Also, I wasn't the one who stated anything about meds and barriers. I have no clue about that. What stands between a person who is UD and unassisted reproduction? RISK. Its like playing Russian roulette with someone else as the potential victim. Just suck it up and find a neg sperm donor, go for sperm washing, or adopt. Don't risk your partner's health. Unless of course in some sense of logic it seems to make sense for one person to become infected with HIV in order to add to a family, then maybe go for it.

Well feel free to post exactly that next time a person posts, wanting to have a baby. Me, I personally opt out of those discussions, as I have no research credibility in that area. All I know is what i read here and elsewhere.

I have never personally encouraged anyone with HIV to have unprotected sex. I merely report what I hear here. Please pick this fight with someone who cares.

JK

*who chooses his areas of expertise and research carefully

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

The link to the 2005 study as posted above lists Indinavir which is brand name Crixivan as crossing the genito barrier. paste again:The marker was not detected in semen from 22 men at 1- and 6-months after peripheral viral suppression due to addition of Indinavir to their ART regimen.

I have not seen a single PRODUCT Label that does not has the same disclaimer you posted above, but the study I linked above states as pasted above, that with the addition of Crixivan, they were able to wipe out the HIV in semen in the 22 study particicpants. You know as well as I do, that if the drug manufacturer stated that the drug wiped out all infectious possibility, that people would be popping the pills like candy and banging like rabbits unprotected, then someone would get infected and sue them to hell and back.

I have not seen a single PRODUCT Label that does not has the same disclaimer you posted above, but the study I linked above states as pasted above, that with the addition of Crixivan, they were able to wipe out the HIV in semen in the 22 study particicpants. You know as well as I do, that if the drug manufacturer stated that the drug wiped out all infectious possibility, that people would be popping the pills like candy and banging like rabbits unprotected, then someone would get infected and sue them to hell and back.

You won't either, when the product hasn't been proven to be shown to reduce the risk of passing HIV to others through sexual contact or blood contamination. Companies would love to jump at being able to say that their drug inhibits HIV transmission. Merck just flat tells you that it doesn't.

Sheeeeesh...and I was gonna ask the question about the possibility of being reinfected by performing oral sex on a woman that is also HIV+

submit it is the same of acquiring HIV through cunnilingus. as close to zero as medical science will allow.

Look statistically at the lesbian population with HIV. Look through thirty years of study. It is zero. I am amazed that this incredible claim is not thoroughly dismissed.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

thanks to you guys for this replies and wonderful informations been provide here i really appreciate it. anyway i learned alot here and still learning.secondly let me be sincere to this i've not have unprotectedsex nor am i planing to do it, but i just threw the question to know what will be the impact in case if will meet next time. though we kiss very deep to extend maybe one day we gonna have sex ,from our discussion i still avoid unprotected sex cause i knew what will be the impact.i always have condom withme no matter anything it most be in my car.thank you for cheering your opinion.san

thanks to you guys for this replies and wonderful informations been provide here i really appreciate it. anyway i learned alot here and still learning.secondly let me be sincere to this i've not have unprotectedsex nor am i planing to do it, but i just threw the question to know what will be the impact in case if will meet next time. though we kiss very deep to extend maybe one day we gonna have sex ,from our discussion i still avoid unprotected sex cause i knew what will be the impact.i always have condom withme no matter anything it most be in my car.thank you for cheering your opinion.san

Um, so you lied about having unprotected sex? have you read the lessons section about how HIV is and is not transmitted? Are you simply playing the forums? What gives?

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

Um, so you lied about having unprotected sex? have you read the lessons section about how HIV is and is not transmitted? Are you simply playing the forums? What gives?

Jkinatl2,please be in mind that from the question it has "question mark" we are about to learn from people that knew morethan me and it thought me alot now .so it's not lie ,the question is simple thanks.

Jkinatl2,please be in mind that from the question it has "question mark" we are about to learn from people that knew morethan me and it thought me alot now .so it's not lie ,the question is simple thanks.

Wow. Just wow.

So noted.

Christ. Thank you for playing us for fools.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

if you re-read the original post, keeping in mind the language difference going on, it can be read as a hypothetical. And Sanitex did come back within 48hrs to dispel us of the wrong interpretation of his bad grammar and incorrect use of the English language.

This certainly is not the first time Sanitex has been misunderstood by members or that members have jumped to the wrong conclusions about what Sanitex was trying to say. I'd bet that it won't be the last time one of his posts is misunderstood either. LOL

but back to the reinfection issue, I wonder how others explain the situation of UD-poz/UD-poz unprotected sex not transmitting HIV since being on medications and being adherent would in effect be both PrEP and PEP in an UD poz person, combined with a low quantity of virus in the semen of another UD positive person. It seems that kind of poz/poz sex would have a low to nil transmission rate.

Also if reinfection is possible then why aren't there more instances of it being reported? Why are UD poz people not reporting sudden virological failure despite adherence? Shouldn't we be seeing a large group of UD poz people who have sero-sorted and had unprotected sex suddenly becoming ill or at least reporting viral spikes?

Part of the reason I ask the questions is that many of these "studies" seemed to be flawed. The Chinese one for example actually has at least a 66% adherence failure rate, so actually that study really just proved that unprotected sex with a viral load is a transmission vector, which we already knew. LOL Others reports are based on only 1 or 2 patients. And still other reports/studies tend to have these same kinds of adherence issues making their conclusion that UD-poz and UD-poz sex is a transmission vector not seem very reliable.

let me be clear, I'm not advocating unprotected sex. I'm just not convinced by inconclusive "evidence" about the topic of reinfection. I'd be happy if someone could explain how meds in the UD-poz person would not act as both PrEP and PEP. And I'd be grateful to see a reasonable study, unflawed by adherence issues, showing UD-poz people suddenly having virological failure. (well, I wouldn't be grateful per se as that would really be a sad study to see; but it would help explain how real reinfection possibly is)